On August 11, 2014, beloved actor and comedian Robin Williams was found dead of what was ruled a suicide. “He had been battling severe depression of late,” his rep said in a statement, as reported by People.com. “This is a tragic and sudden loss.”
“I get bummed, like I think a lot of us do at certain times,” Williams said in a 2006 interview with NPR. You look at the world and go, ‘Whoa.’ Other moments you look and go, ‘Oh, things are okay.’”
Williams was hardly alone: According to the World Health Organization, more than 350 million people worldwide suffer from depression, making it the top cause of disability. Symptoms may include feelings of sadness, angry outbursts, loss of interest in once pleasurable activities, trouble sleeping, changes in appetite and suicidal thoughts or attempts, the Mayo Clinic reports.
For the friends and family of someone struggling with depression, it can often be overwhelming and even intimidating to know what to say (and not to say) to help. Here’s some advice to get started:
“I’ve noticed _______________.”
“You spent the weekend in bed.” “You’re losing weight.” “You haven’t taken a shower or a bath in a day or two.” “When your friends call, you don’t answer the phone.” “When we make your favorite meal, you don’t want to eat it.” “When people invite you to do things that you used to jump at, you don’t want to do it.” Focus on observable, non-judgmental behaviors that can be confirmed by more than one person, says Lloyd Sederer, medical director of the New York State Office of Mental Health and an adjunct professor at Columbia University’s Mailman School of Public Health—not “What’s the matter with you?” or “Don’t you know that if you miss work again today you could lose your job?”
Once you point out the behavior, he suggests saying that as a loving friend or family member, you can’t stand by and watch without feeling concerned and trying to be helpful.
“How can I help you?”
Try to get the depressed person to take one step in the right direction—like setting up an appointment with a therapist, a family doctor or a priest or rabbi—and help him or her follow through on it, whether it’s by finding the medical professional, setting up the appointment or offering a ride, Sederer says.
“Sometimes people with depression don't know where to turn for help. They often don't have the energy and clarity to do the research to find a skillful professional who can assist,” says Steven Meyers, professor of psychology at Roosevelt University in Chicago. “It is a good idea for loved ones to provide this assistance, as this may lead to significant improvement even if the person is initially reluctant or uncertain.”
“It’s hard, but treatment can work.”
Remember that the illness colors a depressed person’s judgment, giving the feeling that there’s no way out or that nothing can help, Sederer explains. Be persistent, firm and non-judgmental, he says, and remind your loved one that, while hard, these are exceptionally common problems. “Over time, [treatment] works and people do get better and recover from these conditions,” he says.
“I’m not going away.”
“You may fight me about this today, but I'll be back tomorrow,” Sederer says. “That's what a good friend, or a loving family member does.”
“Have you thought about hurting yourself?”
While there used to be an old wives’ tale that bringing it up increased someone’s chances of committing suicide, Sederer says that’s not true—the real risk is in not asking at all. For detailed suggestions on how to deal with a suicidal loved one, check out the Mayo Clinic’s tips here.
“I love you.”
“The most helpful things to say include expressions of support and love,” Meyers says. “The willingness to spend time with the person and to engage in enjoyable activities with him or her can be very useful.”
Sometimes listening is more powerful than any words you could ever say, explains Charles Figley, a professor in disaster mental health at Tulane University.
As for what not to say? Sederer suggests avoiding anything critical or that might contribute to your friend or family member’s own self-hatred. Less obvious missteps, such as platitudes (variations on “just cheer up!” for instance), can also do more harm than good. “Despite good intentions, depressed people can feel misunderstood or take these statements as belittlements of the scope of their despair,” Meyers says.
Here are a few phrases to avoid, from the experts:
“Don't you know you need to be taking care of your daughter?”
“Snap out of it.”
“It isn’t so bad.”
“Many people have worse struggles.”
“Don't you know that the pressure is on at work—we need you here!”
“You're acting like a loser.”
The most important thing, Meyers says, is to remain engaged and caring, even if your efforts aren’t always met with the response you’re looking for.
“Often, people with depression will seem despondent despite the love and encouragement received from others. It may even seem as if it doesn't register or is unwelcome,” he says. “However, this isn't true. This level of support is one of the main reasons that keeps a severely depressed person going from one day to the next.”